Clinical Skills Flashcards
A 25 year old presents to the Emergency Centre with stridor. A possible cause for this sign is: A. Pneumonia B. Croup C. Anaphylaxis D. Asthma
C. Anaphylaxis
A 32 year old male is brought into the emergency unit following a motor vehicle accident. You start examining him and hear gurgling noises. You should first:
A. Call a sister to get the intubating equipment and a doctor to come and intubate him.
B. Suction the secretions in his mouth and administer a jaw thrust to open his airway.
C. Ignore the sounds
D. Get the ambubag and start ventilating him.
B. Suction the secretions in his mouth and administer a jaw thrust to open his airway.
You want to defibrillate a patient with a monophasic machine. The correct Joule setting is: A. 100 J B. 200 J C. 300 J D. 360 J
D. 360 J
You are attending to a 40 year old male patient who has been shot in the abdomen. He is anxious, pale peripherally and his vitals are: Pulse 105, Blood Pressure 100/65, Respiratory Rate 24. He is in A. Class I shock B. Class II shock C. Class III shock D. Class IV shock
B. Class II shock
C. Class III shock
Whilst walking around the Emergency Centre, you notice an unconscious patient. On examination she has dilated pupils. A possible cause for this could be: A. Organophosphate overdose B. Heroin overdose C. Morphine administration D. Atropine administration
D. Atropine administration
You respond to a patient who had called the ambulance because he had chest pain. On arrival you find him unresponsive, not breathing (and so give 2 breaths) and pulseless. He was talking to his wife 1 minute before your arrival. You have an AED (automated external defibrillator) with you. Your actions should be:
A. None of these options are correct
B. Start Cardiopulmonary resuscitation and apply the pads after 2 minutes
C. Call for a doctor to come and apply the pads
D. Apply the pads and follow the directions given
D. Apply the pads and follow the directions given
Options:
- Hands over the lower end of the sternum between the nipples
- Compression rate of 100/min and compression depth of 4-5 cm
- Compression: ventilation ratio of 15:2
- Allow full recoil of the chest between compressions
- Lift your hands off the chest between each compression
The correct technique for chest compressions in an adult includes the following: A. 1,2 and 4 B. 1,2,3 and 4 C. 2,3 and 5 D. 1,3 and 5
A. 1,2 and 4
Options:
- Check and open his airway
- Call the ambulance service for help.
- Check his pulse and do CPR for 2 min if needed
- Check his breathing and gives 2 breaths if needed
You are alone and you find your 2 year old brother collapsed on the floor. You assess for hazards and then assess responsiveness. If he is unresponsive your actions (in order) should be: A. 1,4,3 then 2 B. 1,2,3 then 4 C. 2,1,3 then 4 D. 2,1,4 then 3
A. 1,4,3 then 2
Options:
- Bend over/ crouch
- Approach from the front
- Only approach when told you may by the pilot
- Approach from uphill
- Ensure that you have no loose items on you
When approaching a helicopter you should
A. 1,2,3 and 5 B. 1,3 and 5 C. 1,2,4 and 5 D. 1,3,4 and 5
A. 1,2,3 and 5
In the following case scenario choose the best management option.
A 25 year old presents to the emergency unit after overdosing on Heroin. You assess her and find her unresponsive, with a respiratory rate of 0 and Pulse of 60 palpable at carotids.
A. Supply supplemental Oxygen (Venturi or Facemask Oxygen)
B. Ventilate the patient at a rate of 1 breath every 5 sec
C. Ventilate the patient at a rate of 2 breaths every 30 sec
D. Ventilate the patient at a rate of 2 breaths every 30 compressions
B. Ventilate the patient at a rate of 1 breath every 5 sec
In the following case scenario choose the best management option.
A 16 year old presents to the emergency unit with pneumonia. He is fully awake with a respiratory rate of 32 and saturation of 90%.
A. Supply supplemental Oxygen (Venturi or Facemask Oxygen)
B. Ventilate the patient at a rate of 1 breath every 5 sec
C. Ventilate the patient at a rate of 2 breaths every 30 sec
D. Ventilate the patient at a rate of 2 breaths every 30 compressions
A. Supply supplemental Oxygen (Venturi or Facemask Oxygen)
A 40 year old female is brought in by her relatives. They say she has had “flu” for 3 days. Her vitals are: BP 85/40; Heart rate of 135 bpm and Respiratory rate 34. On examination you find Bronchial breathing in her left lower lobe. She is warm peripherally. A. Cardiogenic shock B. Obstructive shock C. Distributive shock D. Hypovolaemic shock
C. Distributive shock
In the following case scenario what type of shock is present.
A 20 year old male is brought in complaining of severe shortness of breath. He has had asthma since he was 8 years of age. His vitals are: BP 85/40; Heart rate 135 bpm and Respiratory rate 28. On examination you find pulsus paradoxus and very soft wheezing bilaterally (almost a silent chest). A. Cardiogenic shock B. Obstructive shock C. Distributive shock D. Hypovolaemic shock
B. Obstructive shock
In the following case scenario what type of shock is present.
A 30 year old male presents to the Emergency Centre after being stung by a bee. His vitals are: BP 85/40, Heart rate of 125 bpm and Respiratory rate of 30bpm. On examination you find generalised urticaria. A. Cardiogenic shock B. Obstructive shock C. Distributive shock D. Hypovolaemic shock
C. Distributive shock
In the following case scenario choose the correct GCS from the options provided:
You are attending to a patient who has been hit on the head with a spade. He opens his eyes when you talk to him, localises to painful stimulus and responds to your questions by using inappropriate words. 3, 5, 3 A. 7 B. 9 C. 10 D. 11
D. 11
In the following case scenario choose the correct GCS from the options provided:
A 17 year old is brought in after being involved in a motor vehicle accident. He is not responding to voice. You administer supraorbital pressure and in response to that he opens his eyes, groans and flexes his elbow, supinates his forearms and flexes his wrists. 2, 2, 3 A. 7 B. 9 C. 10 D. 11
A. 7
IV Indications
Administration of fluid and nutritional support
Administration of IV medications
Administration of blood products
Administration of contrast agents for investigations (e.g. CT scan)
IV Contraindications
There are no absolute contra-indications
Avoid inserting an IV line in a limb that is infected, injured or burned
Avoid using peripheral IV lines for administering irritant medications which can lead to tissue damage (central lines preferred)
Is IV a sterile procedure?
Yes
IV Complications
Pain Failure to access the vein Difficulty advancing the cannular over the needle Haematoma Arterial puncture Thrombophlebitis Skin and soft tissue infection or necrosis Peripheral nerve palsy (rare)
IM Indications
Patient cannot tolerate oral intake
Medication only comes as intramuscular formulation
Require fast onset of action
Focussed administration of medication to a particular area
IM Contraindications
Allergy or previous reaction to the medication
Local skin infection or skin damage at the injection site
Injury to the muscle at the injection site
What is Ampoule?
An ampule, or ampoule, is a tiny single dosage vial with a sealed neck. Ampoules could be of glass or plastic.
The seal is unfastened by cracking the top off the neck, that causes a tidy and hassle-free break without any additional glass shards or slivers. Ampoules cannot be reused and once the sealed neck is snapped off to have access to the drug, it is thrown away.
What is a Vial?
Vial is a small multi-dose container that can hold serums, liquid drugs and other compounds. It is typically made of glass and may or may not be sealed. Vial, in the form of container possesses a screw on cap or a rubber plug.
